Ministry of Health
Registrars will be expected to
present at one journal club during their attachment. Once a month there is
a combined Obstetric-Neonatal Journal Club, where one or two articles of
interest to both disciplines are presented.
Don't underestimate how much time
it might take to get through an article in sufficient detail to present at a
journal club. Critical appraisal of a journal article is a skill that you
need to develop through practice, and evaluating the quality of the evidence
available helps with making clinical decisions in your normal working practice.
Journal clubs are designed to help
with disseminating new information and to learn how to critically appraise
You will need to provide copies of
the article at the session, but you cannot expect the participants to be able to
read the article quickly and completely so you should summarise the information
using overheads or a PowerPoint presentation.
Information which should be included in the journal club summary should
Title and authors and
- Why was this study or
audit undertaken? What was the rationale behind it?
- Are there similar studies
which have looked at the same question?
- Is there biological
plausibility behind the study question?
- This is the most important
section of the presentation, so make sure you understand exactly what it
was that the authors did, and why they chose that particular way to do
- Think about what you might
have done differently if you were trying to answer the same questions.
- Everybody skips over this
because they don’t understand statistics. You will never learn if you
don't spend some time thinking about what the statistics mean.
- Seek some senior
support from someone who has some understanding of what statistics
- Specifically for clinical
trials, you should mention a sample size estimate as this determines
whether they had the numbers to find a relevant difference.
- Whilst this is the bit
that everyone is interested in, be careful here, particularly if you
think the methods are not good. If the methods are flawed, the
results have to be viewed with caution.
- It is best to sift out the
important positive and negative findings, rather than mention them all.
- Are all the participants
accounted for? What was the follow-up like?
- Did they look at any
secondary outcomes which they did not have the power to find differences
- Were the incidences of
events in the study groups the same as that which they based their power
- What are the limitations
of the study?
- Have the findings been
interpreted correctly by the authors?
- Is the study applicable to
our or other populations?
- Should it change our
Don't take it personally
- Finding an article, going
through it in detail for a journal club, and presenting it takes a lot
of time and effort.
- Sometimes an article you
thought was good on reading the abstract does not hold true to that
promise once it has been looked at closely.
- Often the collective
opinion at the meeting is that the study has flaws (almost all studies
do) but this does not mean that it was a bad article to present.
It is often easier to learn from studies which could have been better
than to look at the (few and far between) high quality studies.
There are a number of resources
available that can help you with learning how to read a journal article, but
nothing substitutes continued practice. A useful recent series of articles
are those written by Trish Greenhalgh and published in the
BMJ (Volume 315) in 1997.
For Auckland trainees and
paediatricians, Professor Jane Harding runs an annual critical appraisal course
which is highly recommended.
Carl Kuschel and Malcolm Battin,